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diagnosis hyperkalemia nephrology causes treatment algorithm high hypokalemia comparison hematology pathophysiology product reactions rhabdomyolysis urine alkalosis chloride criticalcare druginduced effects
Mechanisms of Drug-Induced Hyperkalemia • Direct renin inhibitor (Aliskiren) • Renin release inhibition (NSAIDs, Beta-Blockers)
• Increased EC shift ... Benyzlpenicillin, blood ... #hyperkalemia #differential ... pathophysiology #pharmacology ... #potassium #medications
Hyperkalemia Treatment Options Stabilize cardiac membrane: • IV Calcium (peaks 5-10 minutes) Decrease potassium concentration: • IV Fluids Shift
minutes) Decrease potassium ... • IV Fluids Shift ... potassium intracellularly ... peaks 1-2h) • Blood ... #Hyperkalemia #management
Algorithm for patients with hypokalemia on the basis of the potassium-to-creatinine ratio in the urine Urine K+
the basis of the potassium-to-creatinine ... creatinine) • Cell shift ... effective arterial blood ... Bartter syndrome, Gitelman ... #differential #
Hyperkalemia - Management Algorithm • IV calcium • IV insulin and glucose and/or salbutamolt • Consider
Hyperkalemia - Management ... • Consider K+ binder ... Dialysis Serum potassium ... blocks, QRS axis shift ... #hyperkalemia #potassium
Potassium Binders for Management of Hyperkalemia • SPS - Sodium polystyrene sulfonate • Patiromer (veltassa) •
Potassium Binders ... for Management ... cyclosilicate #Potassium ... #Binders #Management ... Hyperkalemia #treatment #pharmacology
Hypokalemia Evaluation Algorithm Before evaluating hypokalemia, life threatening complications such as arrhythmias and paralysis should be looked
treated with IV potassium ... losses: • High Blood ... • Low/Normal Blood ... Bartter syndrome, Gitelman ... diagnosis #Algorithm #differential
Lactated Ringers (LR) vs Normal Saline (NS) - Comparison Composition of LR: • Sodium 130 mEq/L •
130 mEq/L • Potassium ... Can give with blood ... - Citrate in blood ... transcellular shift ... NS #comparison #pharmacology
Hyperkalemia - Differential Diagnosis Framework PseudoHyperkalemia: • Lab error • Traumatic venipuncture • Hemolysis, thrombocytosis, leukocytosis •
Hyperkalemia - Differential ... Crush injury • Blood ... • Recent IV potassium ... Intracellular Shift ... Blood transfusion
Hyperkalemia - Differential Diagnosis Framework PseudoHyperkalemia: • Lab error • Traumatic venipuncture • Hemolysis, thrombocytosis, leukocytosis •
Hyperkalemia - Differential ... Crush injury • Blood ... • Recent IV potassium ... Intracellular Shift ... Blood transfusion
Gitelman Syndrome Overview What? • Inherited (AR) hypokalemic salt-losing tubulopathies affecting the thiazide-sensitive sodium chloride cotransporter • Gitelman's syndrome
Normal or low blood ... Hypokalemia (renal potassium ... ratio 0.5%) Differential ... Supplement: • Potassium ... diagnosis #nephrology #management
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